ADT Use Not Linked to Dementia in Prostate Cancer

Excerpt:

“For men with prostate cancer, use of androgen deprivation therapy (ADT) seems not to be associated with dementia, according to a study published online Nov. 21 in the Journal of Clinical Oncology.

“Farzin Khosrow-Khavar, Ph.D., from McGill University in Hamilton, Canada, and colleagues examined whether use of ADT is associated with increased risk of dementia, including Alzheimer’s disease. A cohort of 30,903 men newly diagnosed with nonmetastatic prostate cancer from April 1, 1988, to April 30, 2015 were recruited and followed until April 30, 2016. To account for delays associated with dementia diagnosis and minimize reverse causality, ADT exposure was lagged by one year.”

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Docetaxel Improves Survival for Men with Hormone-Naive Prostate Cancer

“The addition of docetaxel to standard therapy clinically and significantly improved survival for men with locally advanced or metastatic hormone-naive prostate cancer, according to findings from the STAMPEDE trial.

“However, the addition of zoledronic acid to standard therapy was not associated with improved survival, results showed.

“ ‘We hope our findings will encourage doctors to offer docetaxel to men newly diagnosed with metastatic prostate cancer, if they are healthy enough for chemotherapy,’ Nicholas David James, MD, PhD, director of the cancer research unit at the University of Warwick and consultant in clinical oncology at Queen Elizabeth Hospital in the United Kingdom, said in a press release. ‘Men with locally advanced, nonmetastatic prostate cancer may also consider docetaxel as part of upfront therapy, as it clearly delays relapse.

“ ‘It’s also clear that zoledronic acid does not benefit these patients and should not be offered as an upfront treatment for advanced prostate cancer,’ James said.”


Aspirin Does Not Help to Stave off Death from Prostate Cancer

“Aspirin use does not appear to reduce the risk of mortality associated with prostate cancer, according to research published in the April issue of The Journal of Urology.

“Jonathan Assayag, M.D., of the Jewish General Hospital in Montreal, and colleagues followed a cohort of 11,779 men, diagnosed with nonmetastatic prostate cancer between 1998 and 2009, until 2012. The associations of aspirin use with prostate cancer mortality and all-cause mortality were assessed.

“The researchers found that, at a mean follow-up of 5.4 years, post-diagnostic use of aspirin was associated with increased risks of prostate cancer mortality (hazard ratio [HR], 1.46; 95 percent confidence interval [CI], 1.29 to 1.65) and all-cause mortality (HR, 1.37; 95 percent CI, 1.26 to 1.50). Further analysis showed that the risk of prostate cancer mortality was increased in patients initiating aspirin use after the diagnosis of prostate cancer (HR, 1.84; 95 percent CI, 1.59 to 2.12), but not in those who already were using aspirin before the diagnosis (HR, 0.97; 95 percent CI, 0.81 to 1.16). A similar pattern was observed for increased risk of all-cause mortality associated with post-diagnostic aspirin use (HR, 1.70; 95 percent CI, 1.53 to 1.88), but not pre-diagnostic aspirin use (HR, 0.98; 95 percent CI, 0.87 to 1.18).”


Androgen Deprivation Therapy Has Lasting Impact on Function

“For patients with prostate cancer, androgen deprivation therapy (ADT) has a lasting impact on physical function, according to a study published online March 24 in Cancer.

“Shabbir M.H. Alibhai, M.D., from the University Health Network in Toronto, and colleagues examined the impact of ADT on physical function and quality of life over 36 months. They enrolled 87 men with nonmetastatic  who were starting continuous ADT, and two control groups matched by age and education (86 prostate cancer patients without ADT and 86 healthy controls).

“The researchers found that in both control groups there was an initial improvement in the six-minute walk test which then stabilized, while there was no change for ADT users (P = 0.0030). In control groups, grip strength remained stable, but there was a sharp decline in the ADT group by three months, which then remained stable to 36 months (P = 0.0041). Over 36 months, Timed Up and Go scores declined gradually in the ADT group and did not change in control groups (P = 0.0001). In all groups, the aggregate mental quality of life was stable. Declines seen in the first year of ADT use were independent of age and generally persisted during 36 months.”


Common Prostate Cancer Treatment Associated with Decreased Survival in Older Men

“A common prostate cancer therapy should not be used in men whose cancer has not spread beyond the prostate, according to a new study led by researchers at Henry Ford Hospital.

“The findings are particularly important for men with expectancies because the exposes them to more adverse , and it is associated with increased risk of death and deprives men of the opportunity for a cure by other methods.

“The research study has been published online in European Urology.

“The focus of the new study is androgen deprivation therapy (ADT), in which an injectable or implanted medication is used to disrupt the body’s ability to make testosterone. ADT is known to have significant side effects such as heart disease, diabetes, increased weight gain and impotence; however a growing body of evidence suggests ADT may in fact lead to earlier death.

“Since the 1940s, the therapy has been a mainstay of treatment for prostate cancer that has metastasized, or spread beyond the . Still other studies support the use of ADT when it is used as an adjuvant, or in addition to, for higher risk prostate cancer. No evidence exists to support the exclusive use of ADT for low risk or localized prostate cancer.”


Postdiagnosis Aspirin Use Associated With Reduced Disease-Specific Mortality Only in High-Risk Subgroup of Men With Nonmetastatic Prostate Cancer

The gist: A new study says that men with high-risk nonmetastatic prostate cancer might lower their risk of death by prostate cancer if they take aspirin after being diagnosed. A high dose of aspirin appears to be no better than a low dose.

“A recent analysis of a large clinical database indicated that postdiagnosis aspirin use was associated with a 57% reduction in prostate cancer–specific mortality among men with nonmetastatic prostate cancer. In a study in a prospective cohort reported in the Journal of Clinical Oncology, Jacobs et al found that postdiagnosis aspirin use was associated with reduced disease-specific mortality only among men with high-risk cancers, with no obvious difference in outcome according to aspirin dose being detected in this subgroup…

“The study included men diagnosed with nonmetastatic prostate cancer in the Cancer Prevention Study-II Nutrition Cohort between enrollment in 1992 or 1993 and June 2009. Aspirin use was recorded at enrollment, in 1997, and every 2 years thereafter. Through 2010, there were 441 prostate cancer deaths among 8,427 prostate cancer cases with information on prediagnosis aspirin use and 301 deaths among 7,118 cases with information on postdiagnosis aspirin use.

“Multivariate analyses of prostate cancer-specific mortality included adjustment for age at diagnosis, race, year of diagnosis, tumor extent (T1–T2 or T3–T4), nodal involvement, Gleason  score (2–6, 7, ≥8, unknown), initial treatment type, use of cholesterol-lowering drugs, cardiovascular disease, and prediagnosis prostate-specific antigen testing not leading to a prostate cancer diagnosis.”


ADT Linked to Acute Kidney Injury Risk in Nonmetastatic Prostate Cancer

“Androgen deprivation therapy (ADT) was significantly associated with an increased risk for acute kidney injury among men with nonmetastatic prostate cancer, according to study results. ‘Although ADT has been shown to have beneficial effects on prostate cancer progression, serious adverse events can occur during treatment,’ Francesco Lapi, PharmD, PhD, of the Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, and colleagues wrote. ‘By lowering testosterone to castration levels, ADT may antagonize the vasodilating effects of testosterone on renal vessels while also creating an estrogen deficiency, which can negatively affect renal tubular function. Thus, it is possible that through these mechanisms, the use of ADT may increase the risk of acute kidney injury.’ “


Hormone Use in Prostate Cancer May Harm Kidneys

“Men with nonmetastatic prostate cancer had a significantly increased risk of acute kidney injury when treated with androgen deprivation therapy (ADT), data from a retrospective analysis showed. Current use of any form of ADT more than doubled the odds of acute kidney injury as compared with men not receiving ADT, according to Samy Suissa, PhD, of Jewish General Hospital in Montreal, and co-authors. The strongest effect on kidney injury came from combined treatment with gonadotropin-releasing hormone (GnRH) agonists and antiandrogens, followed by estrogen, other combination therapies, and GnRH monotherapy. Bilateral orchiectomy and monotherapy with an antiandrogen did not significantly affect the risk of acute kidney injury, they reported online in JAMA.”